Swelling after inguinal hernia surgery or umbilical hernia surgery is quite common. Most of the time, swelling after hernia surgery is normal and not a sign of a problem. The most common reason for swelling is the body’s normal response to surgery.
In the beginning phases of healing, the body produces extra fluid that helps with the healing process. This fluid brings nutrients and cells that can help tissues repair themselves, and appears as swelling at the site where there was an injury to the tissues (similar to swelling after a sprained ankle). When this swelling sits in one area for a few days, it often turns hard and can feel like a firm lump. Therefore, in umbilical hernias, typically the incision and the hernia are very close to each other, and many patients will feel a hard lump near the umbilicus that forms several days after surgery. Similar swelling occurs after epigastric and open incisional hernia surgery. Swelling after inguinal hernia surgery often occurs where the incision is as well as below, often extending to the groin and even the scrotum and testicles. Because gravity pulls down on the normal fluid that the body creates, many people feel like their testicles are swollen and sore after hernia surgery. Since normal swelling after hernia surgery is part of the healing process, the body can take three to six months to get rid of the swelling. In patients with very large inguinal hernia that extend down to the scrotum, sometimes the swelling may be there for longer than six months.
Sometimes, a few drops of blood can change the color of the skin to black and blue after surgery. Similar to swelling, this can occur around the incision, as well as lower down in the groin in inguinal hernia surgery. Gravity can pull the drops of blood down to the penis and scrotum, often times turning them black and blue. Black and blue discoloration is normal after hernia surgery and will resolve much faster than the swelling after hernia surgery. Black and blue discoloration will often turn into yellow discoloration and fade before most people’s appointment after surgery.
Many people notice swelling after hernia surgery and wonder if that swelling is normal or not. In the paragraphs above, we described why people get swelling and that it is usually because of normal healing. What people often describe is a hard lump under the incision that feels like a marble. Many people are concerned that their hernia has returned. They are often reassured when they notice that the hard lump does not come in and out of their abdomen, as a hernia would. Typically there is mild pain or discomfort where the swelling is, but there is a pattern of improvement in the days and weeks following surgery.
Sometimes the swelling is soft and does not seem to go away after surgery. Again, this is most likely due to the body’s normal fluid pooling in the space the hernia used to be. If this swelling persists longer than three to six months after surgery, it should be re-evaluated by the surgical team to determine if hernia has recurred. Unfortunately, x-rays, CT scans and MRI’s are often not sensitive enough immediately after surgery to tell the difference between the body’s normal fluid and a possible problem. Time is the only thing that helps tell us if there is a problem or not in these situations.
While most swelling after hernia surgery is normal, it can rarely be an indicator of a complication, including infection and hernia recurrence. Swelling after hernia surgery is rarely sign of infection. Since infection from hernia surgery occurs less than 1% of the time, swelling is normal in the other 99% of the time. Pain or swelling that continues to worsen after hernia surgery, or pain and swelling accompanied by red discoloration of the skin are signs of infection and require attention by the surgical team. Many surgeons work in teams made up of medical assistants, nurses, nurse practitioners, physician assistants or other surgeons. Infection are uncommon and abnormal after hernia surgery, so it is important to see a medical provider if any of the symptoms of infection are present.
Early swelling can also occasionally indicate hernia recurrence. In umbilical, epigastric and incisional hernias, the hernia can return in as many as 20% (one in five) patients. In inguinal hernia, the hernia returns in as many as 10% of patients, depending on the type of hernia surgery performed. In our experience, less than 1% of patients has a recurrent hernia when they have an inguinal hernia repaired in our practice. If swelling after hernia surgery first occurs many months after the surgery, a visit to the surgeon is required to evaluate for possible hernia recurrence or infection.